子宫内膜不典型增生患者术后病理升级的高危因素分析

发布时间：2018-01-21 13:05

本文关键词： 子宫内膜不典型增生病理升级高危因素　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：回顾性分析98例子宫内膜不典型增生患者的临床病例资料，评价诊断性刮宫、宫腔镜下定点活检及术中冰冻病理的诊断价值；分析漏诊原因；探寻可以预测子宫内膜不典型增生升级的高危因素。材料和方法：选取2003年01月01日-2013年12月31日因子宫内膜不典型增生在大连医科大学附属第一医院妇科接受子宫切除术的98例患者的临床资料进行回顾性分析。比较入组病例术前病理、术中冰冻以及术后石蜡病理结果，总体评估诊断性刮宫与宫腔镜下定点活检及术中冰冻病理在子宫内膜不典型增生诊断中的价值；根据术后石蜡切片病理结果将病例分为非子宫内膜癌组和子宫内膜癌组，比较两组病例的年龄、绝经状态、体重指数（BMI）、生育情况、合并症（高血压、糖尿病、其他恶性肿瘤史）、临床表现、肿瘤标记物（血清CA125）、超声提示子宫内膜厚度及血流情况等相关因素，探寻可以预测EAH患者中升级为子宫内膜癌的高危因素。统计方法：采用SPSSl7．0统计学软件进行数据分析，PO.05有统计学意义。结果： 1.入组的98例病例中，术后石蜡切片病理证实仍为子宫内膜不典型增生的有61例（62.24%）；升级为子宫内膜癌的有37例（37.76%），其中36例为子宫内膜样腺癌，1例合并鳞癌成分。Ia期病例约占81.08%（30/37）；Ib期病例约占5.41%（2/37）；II期病例约占5.41%（2/37）；III期病例约占8.11%（3/37）。高分化癌约占72.97%（27/37），中分化癌约占21.62%（8/37），低分化癌约占5.41%（2/37）。 2.术后石蜡切片病理诊断与术前不典型增生分度有关，随着EAH分度的增加，升级为子宫内膜癌也有增加趋势。轻、中、重度不典型增生中升级为子宫内膜癌的概率分别为：11.76%（2/17）、10.53%（4/38）、80%（28/35）。 3.诊断性刮宫与宫腔镜下定点活检对子宫内膜不典型增生病例手术前后病理的诊断符合率分别为61.84%（47/76），63.64%（14/22）；两组子宫内膜癌的漏诊率分别为38.16%（29/76），36.36%（8/22）。 4.术中冰冻病理对子宫内膜癌诊断的敏感性为63.64％，特异性65％，阳性预测值66.67％，阴性预测值61.9％，总准确率为64.29%。术中冰冻病理对子宫内膜癌的漏诊率为36.36%。 5.单因素分析：绝经、肥胖、超声提示子宫内膜增厚及血流情况等参数对预测子宫内膜不典型增生病例升级为子宫内膜癌有统计学意义；多因素Logistic回归分析后仅肥胖、超声提示内膜血流丰富有统计学意义。结论： 1.术前诊断为EAH，而术后石蜡切片病理证实为子宫内膜癌的患者，绝大多数为早期、分化程度较好的子宫内摸样腺癌； 2.随着术前EAH分度的增加，术后石蜡病理诊断升级为子宫内膜癌有增加趋势； 3.术前用诊断性刮宫、宫腔镜下定点活检病理以及术中冰冻病理对子宫内膜癌的诊断，均存在一定的假阴性，需谨慎对待； 4.伴有肥胖的EAH患者，如果超声提示内膜血流较丰富，，应高度警惕有升级为子宫内膜癌的可能。
[Abstract]:Objective: to retrospectively analyze the clinical data of 98 cases of endometrial atypical hyperplasia and evaluate the diagnostic value of uterine curettage, hysteroscopic fixed point biopsy and intraoperative frozen pathology. Analyze the causes of missed diagnosis; To explore the risk factors for predicting the progression of endometrial atypical hyperplasia. Materials and methods:. Clinical data of 98 patients undergoing hysterectomy in the first affiliated Hospital of Dalian Medical University from January 1st 2003 to December 31st 2013 due to atypical hyperplasia of endometrium were selected. Retrospective analysis. The preoperative pathology of the patients was compared. The clinical value of intraoperative frozen and paraffin paraffin pathological findings, diagnostic curettage and hysteroscopic biopsy, and intraoperative frozen pathology in the diagnosis of endometrial atypical hyperplasia were evaluated. According to the pathological results of paraffin section, the patients were divided into two groups: non-endometrial carcinoma group and endometrial carcinoma group. The age, menopausal status, body mass index (BMI), fertility status, complications (hypertension) were compared between the two groups. Diabetes, other malignant tumor history, clinical manifestations, tumor markers (serum CA125), ultrasound to indicate endometrial thickness and blood flow and other related factors. To explore the risk factors for progression to endometrial carcinoma in EAH patients. Statistical methods: SPSSl7.0 statistical software was used to analyze the data of PO.05 with statistical significance. Results: 1. Among the 98 cases in the group, 61 cases were confirmed as atypical hyperplasia of endometrium by paraffin section after operation. 37 cases of endometrial carcinoma were upgraded to endometrial carcinoma, of which 36 cases were endometrial adenocarcinoma and 1 case was complicated with squamous cell carcinoma. The proportion of Ib cases was about 5.41 / 37; The proportion of stage II cases was about 5.41 / 37; Cases of III accounted for about 8.11 / 37, well-differentiated carcinoma accounted for about 72.97 / 37 and moderately differentiated cancer accounted for 21.62 / 837). Poorly differentiated cancer accounts for about 5.41 / 37. 2.The pathological diagnosis of paraffin section after operation is related to the degree of atypical hyperplasia before operation. With the increase of EAH grade, there is an increasing tendency to upgrade to endometrial carcinoma. The odds of progression to endometrial cancer in severe dysplasia are as follows: 11. 76 / 17 / 10. 53, 10 / 4 / 38 / 80 / 35. 3. Diagnostic curettage and hysteroscopic biopsy for atypical hyperplasia of endometrium before and after operation, the diagnostic coincidence rate was 61.84 / 47 / 76, respectively. 63.64 / 22; The rate of missed diagnosis for endometrial carcinoma in the two groups was 38.16 / 29 / 76 / 36.36 / 32. 36%, respectively. 4. The sensitivity of intraoperative frozen pathology to the diagnosis of endometrial carcinoma was 63.64, the specificity was 65, the positive predictive value was 66.67, and the negative predictive value was 61.9%. The total accuracy was 64.29.The rate of missed diagnosis of endometrial carcinoma by intraoperative frozen pathology was 36.36. 5. Univariate analysis: the parameters of menopause, obesity, ultrasound indicating endometrial thickening and blood flow were statistically significant in predicting endometrial atypical hyperplasia to endometrial carcinoma. Multiple factor Logistic regression analysis was only obesity, ultrasound showed that the intimal blood flow was significant. Conclusion: 1. EAH was diagnosed preoperatively, and the majority of patients with endometrial carcinoma confirmed by paraffin section after operation were early and well-differentiated intrauterine stromal adenocarcinoma. 2. With the increase of preoperative EAH, postoperative paraffin wax pathological diagnosis of endometrial carcinoma has an increasing trend; 3. The diagnosis of endometrial carcinoma with diagnostic curettage, hysteroscopy and intraoperative frozen pathology were all false negative and should be treated with caution. 4. Patients with EAH with obesity should be highly alert to the possibility of progression to endometrial carcinoma if ultrasound indicates that endometrial blood flow is abundant.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.4

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